Minimal Ovarian Stimulation With Clomiphene Citrate: A Large-Scale Retrospective Study

Reprod Biomed Online. 2007 Aug;15(2):134-48. doi: 10.1016/s1472-6483(10)60701-8.

Abstract

Enclomiphene, an isomeric component of clomiphene citrate, acts antagonistically to the oestradiol receptor at the hypothalamus level, inhibiting both negative and positive feedback, and resulting in the induction of ovarian stimulation and suppression of ovulation. The minimal ovarian stimulation protocol takes full advantage of these characteristics of clomiphene citrate. Administration of 50 mg clomiphene citrate is initiated on cycle day 3, and from day 8 patients receive 150 IU of FSH every other day. When the size of the dominant follicle and the oestradiol concentration reach the predefined values, gonadotrophin-releasing hormone agonist is administered to induce follicular maturation. Oocytes are then retrieved 32-35 h later. Because the short half-life of enclomiphene (24 h) is of critical importance in this protocol, it is necessary to continue oral administration of clomiphene citrate until the day before maturation is triggered. Of all 43,433 cycles initiated, the rates for oocyte retrieval and embryo cleavage were 83 and 64% respectively. The mean number of oocytes retrieved was 2.2. The rates for live births, miscarriages, and ectopic pregnancies, in relation to initiated cycles, including cases of frozen-thawed transfer, were 11.1, 3.4 and 0.2% respectively.

MeSH terms

  • Adult
  • Clomiphene / administration & dosage*
  • Embryo Transfer
  • Enclomiphene*
  • Estradiol / blood
  • Female
  • Fertility Agents, Female / administration & dosage
  • Follicle Stimulating Hormone, Human / administration & dosage
  • Gonadotropin-Releasing Hormone / agonists
  • Humans
  • Infertility, Female / drug therapy*
  • Luteinizing Hormone / blood
  • Menotropins / administration & dosage
  • Middle Aged
  • Oocytes / growth & development
  • Ovulation Induction / methods*
  • Pregnancy
  • Pregnancy Rate
  • Retrospective Studies
  • Selective Estrogen Receptor Modulators / administration & dosage*

Substances

  • Fertility Agents, Female
  • Follicle Stimulating Hormone, Human
  • Selective Estrogen Receptor Modulators
  • Clomiphene
  • Gonadotropin-Releasing Hormone
  • Estradiol
  • Menotropins
  • Luteinizing Hormone
  • Enclomiphene